Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Diabetes Care. 2013 Apr;36(4):985-91. doi: 10.2337/dc12-1116. Epub 2012 Dec 5.
The influence of diabetes on cardiac resynchronization therapy (CRT) remains unclear. The aims of the current study were to 1) assess the changes in left ventricular (LV) systolic and diastolic function and 2) evaluate long-term prognosis in CRT recipients with diabetes.
A total of 710 CRT recipients (171 with diabetes) were included from an ongoing registry. Echocardiographic evaluation, including LV systolic and diastolic function assessment, was performed at baseline and 6-month follow-up. Response to CRT was defined as a reduction of ≥15% in LV end-systolic volume (LVESV) at the 6-month follow-up. During long-term follow-up (median = 38 months), all-cause mortality (primary end point) and cardiac death or heart failure hospitalization (secondary end point) were recorded.
At the 6-month follow-up, significant LV reverse remodeling was observed both in diabetic and non-diabetic patients. However, the response to CRT occurred more frequently in non-diabetic patients than in diabetic patients (57 vs. 45%, P < 0.05). Furthermore, a significant improvement in LV diastolic function was observed both in diabetic and non-diabetic patients, but was more pronounced in non-diabetic patients. The determinants of the response to CRT among diabetic patients were LV dyssynchrony, ischemic cardiomyopathy, and insulin use. Both primary and secondary end points were more frequent in diabetic patients (P < 0.001). Particularly, diabetes was independently associated with all-cause mortality together with ischemic cardiomyopathy, renal function, LVESV, LV dyssynchrony, and LV diastolic dysfunction.
Heart failure patients with diabetes exhibit significant improvements in LV systolic and diastolic function after CRT, although they are less pronounced than in non-diabetic patients. Diabetes was independently associated with all-cause mortality.
糖尿病对心脏再同步治疗（CRT）的影响尚不清楚。本研究旨在：1）评估左心室（LV）收缩和舒张功能的变化；2）评估 CRT 受者的长期预后。
从正在进行的注册研究中纳入了 710 例 CRT 受者（171 例患有糖尿病）。在基线和 6 个月随访时进行超声心动图评估，包括 LV 收缩和舒张功能评估。CRT 反应定义为 6 个月随访时 LV 收缩末期容积（LVESV）减少≥15%。在长期随访（中位数=38 个月）期间，记录全因死亡率（主要终点）和心脏死亡或心力衰竭住院（次要终点）。
在 6 个月随访时，糖尿病和非糖尿病患者均观察到明显的 LV 逆重构。然而，非糖尿病患者的 CRT 反应发生率高于糖尿病患者（57%比 45%，P<0.05）。此外，糖尿病和非糖尿病患者的 LV 舒张功能均显著改善，但非糖尿病患者更为明显。LV 不同步、缺血性心肌病和胰岛素使用是糖尿病患者 CRT 反应的决定因素。糖尿病患者的主要和次要终点更为频繁（P<0.001）。特别是，糖尿病与缺血性心肌病、肾功能、LVESV、LV 不同步和 LV 舒张功能障碍一起与全因死亡率独立相关。
尽管糖尿病心力衰竭患者 CRT 后 LV 收缩和舒张功能的改善程度不如非糖尿病患者明显，但仍有显著改善。糖尿病与全因死亡率独立相关。
